Can you trust what you see here?

My name is Jim Phelps. I’m a psychiatrist. I specialize in complex mood and anxiety disorders including “treatment resistant depression” and bipolar disorders. Most people I see with depression have already had 3 different antidepressants and often at least one good psychotherapist, and they’re still struggling. So over the years I’ve focused on how to treat that group of people. Not all of them have “bipolar disorder”, but “bipolarity” is the most treatable reason to still be struggling after all this treatment. (More common is PTSD, but not often not as treatable).

So after explaining the things you’ll find on this site to many patients, and to my primary care colleagues, I thought this might be easier if I just wrote them down. It has been an easy way to make this story available. You’re welcome to it. I’ve picked the stuff that most people want to know, and written it the way I tell it out loud. Hopefully by reading here you’ll learn enough to decide — for yourself — whether any of this applies to you.

What’s in it for Dr. Phelps?

You might wonder why I’m doing this: where’s the payoff? Good question, one you should ask of any website like this. Here’s the answer. I built this site in about the year 2000, adding to it and updating steadily since then. So it is a convenient resource for me. And getting emails from people who have been helped by reading here keeps me going.

This site receives no financial support from pharmaceutical companies or my employer-hospital or anywhere else. In its first year, I asked two pharmaceutical companies for a grant to help me get it started. That was in 2001 to 2003. Keeping a website up costs almost nothing, so I’ve not sought any further grants. Nice to be independent of that! For many more details, if you’re skeptical (that’s fine, and wise), see my Funding page.

How do you decide what to trust?

Don’t believe what you read here. Really. Be as skeptical as you want. Bipolar disorder is not a disease you want to have, that’s for sure. I really hope you’ll look at some of the many references in here. When you see a name hanging like thisPhelps, click it. That’s the article which supports the point I’m trying to make. Keep your skepticism and wait for people to offer you references to evidence. The references I cite are generally the best evidence available — based on my opinions, of course.

Don’t take it from me: read, ask questions, wonder out loud. Complex mood disorders can be extremely tricky, both in diagnosis and treatment. Eventually I hope you’ll know enough to participate very actively in each decision about your care.

What you can do is evaluate the “evidence”. Most of the national experts whose opinion I refer to here have had to meet a tough standard of evidence for their research. You should trust them over someone who has not had to test their theory. If you know what a randomized trial is, and why that is the best thing to trust, skip the next section.

Placebos and research

Placebos — an inactive pill or treatment — work quite well for mood and anxiety disorders. About 25-30% of people with these problems will see their symptoms decrease at least by half with a placebo alone. Amazing. That doesn’t mean they didn’t have a serious problem. It means that our brains/minds are remarkable: if somehow you believe you’re going to get better, this starts some process that can indeed make you better.

Thus someone who offers you a treatment should be able to show that their treatment is better than a placebo! And the best way to show that is to test them, one against the other. When participants are assigned by chance to receive the placebo or active treatment, that’s a “randomized trial.” If you have a choice of a treatment that has been shown effective this way, versus one that has not— well, here’s how my teacher put it: “Jim, there are a lot of treatments out there; why don’t you start with the ones that have some evidence that they work?” (more on evidence, if you want)

No substitute for evaluation

This site is not intended to substitute for evaluation by a mental health specialist. If you have a suspicion about your diagnosis and do not have access to a psychiatrist (an M.D. doctor, who can prescribe medication), often a good local therapist (Ph.D., MSW, or LCSW) can be helpful with a diagnostic evaluation. Even if you do have “bipolar disorder”, the therapist may be able to help a lot with coping, adjusting, and handling your stresses (caused by the illness, or by something else!).

Once you are more certain about the diagnosis, if it is impossible for you to get to a psychiatrist, you could — with caution– approach your primary care provider about treatment. Here’s a page about how to work with them.

Cautions: opinions, labels, and false hope

This site is basically a guide to the medical literature on bipolar variations. Most important concepts will be referenced: that means I am referring you to the source of the information. Where there is strong disagreement among experts, I will try to point that out. If I offer an opinion in an area of controversy, I will try to make it clear that it is my opinion.

You should interpret my opinions with caution. I could be completely wrong. As I tell my patients, “the proof is in the pudding”. The “right” approach is ultimately defined by “what works”. If you get better, and stay better, you were right about something! That’s what matters. The “label” was only supposed to help guide treatment, and indicate what other people you might be like, so that their experience could be a guide for you. If you are better, you don’t much need any particular label anymore!

However, you must guard against false hope. If you come to believe you might have a bipolar variation, and get your hopes up about a new potential treatment, you could be very disappointed if the treatment doesn’t work. In that case my information here could have hurt you. So, you will be safer if you approach everything you read skeptically. Wait for the treatment to be effective before you really believe the “diagnosis”, ok? (more on Hope, tricky stuff)

Finally, from a legal point of view, please understand that I am offering information as I understand it, not advice. I hope you find something useful, though.